Raija Kallio

C-reactive protein, procalcitonin and interleukin-8 in the primary diagnosis of infections in cancer patients

The diagnostic utility of C-reactive protein (CRP), procalcitonin (PCT) and interleukin-8 (IL-8) were studied in 66 cancer patients with suspected infection (39 with definite foci of infection, 17 with antibiotic responses without foci and 10 with neoplastic fever without infection) and 26 patients scheduled for chemotherapy. The infection group (n=56) had higher median CRP (91 versus 19 mg/l, P<0. 001), PCT (0.28 versus 0.12 ng/ml, P<0.001) and IL-8 values (27.7 versus 16.9 pg/ml, P=0.032) than the non-infection group (n=36). In patients with suspected infection, only PCT was a good marker to discriminate bacteraemia with an area under the receiver operating characteristics curve of 0.92 (95% confidence interval (CI), 0.77-1. 0), but even PCT was less well able to differentiate between non-bacteraemic infections and neoplastic fever (0.56; 95% CI, 0. 35-0.77). In conclusion, PCT was a good indicator for bacteraemia, but none of the three markers were reliable indicators for minor infections in non-neutropenic cancer patients.

Balance between interleukin-10 and interleukin-12 in adult cancer patients with or without infections.

Reliable markers for identifying infections in cancer patients on admission are lacking. The utility of the balance between interleukin (IL)-10 and IL-12 was analysed in this respect. The infection group (n=56) had higher median serum levels of IL-10 (3.8 pg/ml; interquartile range (IQR) 1.7-11.4 pg/ml versus 1.8 pg/ml; IQR 0.6-4.6 pg/ml; P=0.005) and IL-10 to IL-12 ratio (0.4; IQR 0.06-4.23pg/ml versus 0.05; IQR 0.02-0.31pg/ml; P<0.001) than the non-infection group (n=36). IL-10 and the ratio had the following figures of sensitivity (79%; 95% confidence interval (CI) 66-88 versus 39%; 95% CI 27-53), specificity (40%; 95% CI 12-74 versus 90%; 95% CI 56-100) and positive predictive value (88%; 95% CI 76-96 versus 96%; 95% CI 78-100) for identifying infections (56 cases with infection and 10 with neoplastic fever), and the corresponding area under curve (AUC) values for IL-10 and the ratio in identifying infections in general were 0.58; 95% CI 0.39-0.78 versus 0.64; 95% CI 0.46-0.82 and in bacteraemia 0.71; 95% CI 0.50-0.92 versus 0.75; 95% CI 0.58-0.93, respectively. Thus, IL-10 can be used as a screening method for identifying infections in cancer patients and the ratio of IL-10 to IL-12 for confirming the diagnosis.

Expression of CD11b/CD18 adhesion molecules on circulating phagocytes—a novel aid to diagnose infection in patients with cancer

Goals of workNo blood marker available to date is useful for distinguishing infection-related from neoplasm-related fever. We evaluated the expression of the peripheral blood phagocyte CD11b/CD18 adhesion molecule complex for this purpose.Materials and methodsNeutrophil and monocyte CD11b/CD18 expression was assessed in two cohorts of patients with advanced solid cancer (n = 120) and in healthy controls (n = 63). The cancer series included 89 patients with verified infection, 23 without infection, and eight with neoplastic fever. CD11b/CD18 expression was measured using flow cytometry, and serum C-reactive protein (CRP) concentration was determined with immunoturbidimetric assay.ResultsCancer patients with infection had higher blood neutrophil and monocyte CD11b/CD18 expression levels than patients with neoplastic fever, those with advanced cancer without infection, or healthy controls (p < 0.01 for all analyses). High CD11b/CD18 values were measured exclusively in individuals diagnosed with infection. Receiver-operating characteristic area under the curve (AUC) for neutrophil and monocyte CD11b/CD18 expression for the discrimination of infection from neoplastic fever was 0.80 (95% CI, 0.70 to 0.88), which was superior (p = 0.039 and p = 0.049, respectively) to serum CRP on admission (AUC 0.51, 0.40 to 0.62).ConclusionsPeripheral blood phagocytic cell CD11b/CD18 expression is useful for making a differential diagnosis between infection and neoplasm-related fever in cancer patients.

MRI-guided laser ablation of neuroendocrine tumor hepatic metastases:

Background Neuroendocrine tumors (NET) represent a therapeutically challenging and heterogeneous group of malignancies occurring throughout the body, but mainly in the gastrointestinal system. Purpose To describe magnetic resonance imaging (MRI)-guided laser ablation of NET liver metastases and assess its role within the current treatment options and methods. Material and Methods Two patients with NET tumor hepatic metastases were treated with MRI-guided interstitial laser ablation (LITT). Three tumors were treated. Clinical follow-up time was 10 years. Results Both patients were successfully treated. There were no local recurrences at the ablation site during the follow-up. Both patients had survived at 10-year follow-up. One patient is disease-free. Conclusion MRI-guided laser ablation can be used to treat NET tumor liver metastases but combination therapy and a rigorous follow-up schedule are recommended.